Priapism

What is Priapism?

Priapism is a disorder in which the penis maintains a prolonged erection in the absence of appropriate stimulation. There are three main types of priapism-

• Ischemic
• Non-ischemic
• Recurrent ischemic

Ischemic driven priapism is an emergency condition and requires prompt intervention to prevent the damage to the penis. If left untreated, penile necrosis occurs leading to fibrosis. Globally, the overall incidence of priapism is 1.5 cases per 100,000 person-years.

Aetiology

In about two thirds of patients, the cause of priapism is the use of intracavernosal drugs that are used in treating erectile dysfunction. The etiology can be categorized as-

• Low flow (ischemic priapism): characterized by low arterial flow in the corpora cavernosa resulting in prolonged rigid erection which is painful. Causes include sickle cell disease, thalassemia, vasoactive medications etc.
• High flow (non-ischemic priapism): This is caused by unregulated arterial blood flow into corpora cavernosa without any venous trapping. Patients do not develop ischemia and the erection is painless.

Sign and symptoms

History of an erection lasting an abnormally long period in the absence of stimulation with associated pain will be elicited. The absence or presence of pain is important in distinguishing between ischemic and non-ischemic priapism. No engorgement of glans penis and corpus spongiosum will be seen.

Diagnosis

A comprehensive history and physical examination are sufficient to determine the underlying cause and the treatment protocol to be followed.

On physical examination, the penis should be palpated to determine the presence of palpable pulsation as this may represent arterial high-flow priapism and is usually absent in ischemic conditions. In ischemic priapism, the corpora cavernosa is usually tender to palpation, and the absence of tenderness or partially tumescent cavernosa tends to favour a diagnosis of non-ischemic disease.

Penile imaging techniques like CDU (Color duplex ultrasound), MRI (Magnetic resonance imaging) and MRA (Magnetic resonance angiography) may be performed for the diagnosis.

General management

Though ischemic priapism is a medical emergency and requires immediate intervention to avoid irreversible damage and erectile dysfunction, symptomatic relief may be given to the patient through pharmacological intervention for other types of priapism.

Warning: Above information provided is an overview of the disease, we strongly recommend a doctor's consultation to prevent further advancement of disease and/or development of complications.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.